ABSTRACT
PURPOSE: The supply of donor organs does not meet the demand of transplantation. To find a possible way of expanding the donor pool, we have evaluated the risk factors of cadaveric donors that influence the graft survival. METHODS: Between Feb. 1995 and Dec. 1999, we performed 200 cases of cadaveric kidney transplantation. The graft survival rates in 1 yr, 2 yr, & 3 yr are 93.0%, 91.1%, & 89.9%, respectively. We defined the marginal donor as a donor who possesses one of the risk factors of donor age > or = 50, or or =10 days (n=46), history of hypertension (n=30), CPR > or =20 min (n=7), prolonged hypotension (SBP or =20microgram/kg/min, or dobutamine > or =15microgram/kg/min) (n=78), serum creatinine level > or =2.5 mg/dl (n=16), or cold ischemic time > or =12 hr (n=34). We compared graft survival rates between the marginal donor group and the non-marginal donor group, and analyzed risk factors affecting graft survival by univariate and multivariate methods. RESULTS: CPR > or =20 min (71.5%, 71.5%, - vs 93.8%, 91.8%, 90.6%, p=0.027), prolonged hypotension (85.0%, 85.0%, 80.3% vs 95.0%, 92.6%, 92.6%, p=0.028) and serum creatinine > or =2.5 mg/dl (75.0%, 75.0%, 75.0% vs 94.6%, 92.4%, 91.0%, p=0.001) affect graft survival in univariate analysis. There is, However, no risk factor that affects graft survival in multivariate analysis. CONCLUSION: We can increase the supply of donor organs for kidney transplantation by the selective use of high-risk cadaver donor. However, a prospective randomized study including recipient factors is needed to define the acceptable conditions better.
Subject(s)
Risk FactorsABSTRACT
PURPOSE: Thanks to hepatitis B immune globulin (HBIG) and antiviral agents such as Lamivudine , HBV cirrhosis is no longer a contraindication of liver transplantation. Actually it is frequent indication for liver transplantation in Korea. However, to date, the most effective HBV prophylaxis regimen has not been determined. The purpose of this study was to evaluate whether the regimen consisting of lamivudine and one-week HBIG for the hepatitis B virus (HBV) prophylaxis following liver transplantation is as effective as a long-term therapy of high dose HBIG. METHODS: From May 1996 to December 1999, 58 patients among a total of 80 cases of liver transplantation were hepatitis B surface antigen positive preoperatively. They were grouped into two protocol regimens, the HBIG group and the Lamivudine combination group, at random. 43 patients (19 patients in the HBIG group, twenty four patients in the Lamivudine combination group) who survived more than 90 days were included in this study. The recurrence was defined as the conversion of HBs-Ag from negative to positive. RESULTS: There was no statistical significance between the two groups in regards to age, sex or the preoperative positive rate of HBeAg. The mean follow-up duration was 27 months (range from 6-55). Of the 43 patients, 5 patients were converted to HBs-Ag positive in serum; two were in theHBIG group and three in the Lamivudine combination group. There was no statistical significance in HBV recurrence rate between the two groups (p=0.97). CONCLUSION: The combined therapy of lamivudine and one week HBIG has an effect equivalent to a long term therapy of high dose HBIG in HBV prophylaxis following liver transplantation.